MEDICARE: JESSICA WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT21907045	IN

General Provider Information

NPI Number	:	1386284487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA WRIGHT

Provider Business Mailing Address
First Line	:	498 LOWRY WAY
Second Line	:
City	:	ROANOKE
State	:	IN
Zip	:	46783-9196
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 RUSTON PASS STE B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1572
Country	:	US
Telephone Number	:	360-201-7718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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Directions to “ JESSICA WRIGHT ” Practice Location

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